Appendix A - Hertfordshire Mapping of ASD Service provision Refer on to Interventions Criteria Referrers Hertfordshire Community NHS Trust (HCT) Hertfordshire County Council Hertfordshire County Council East & North Hertfordshire NHS Trust Hertfordshire Community NHS Trust Challenging Behaviour Children’s Social Care Psychology Service (CBPS) being re-commissioned 2014 ISL Community Paediatricians Part time Psychologists Specialist HV – East & North Hertfordshire Community Paediatricians (West Herts) Specific Health Professionals including Child Development Centre Professionals CAMHS - tier 3 and 4 Tertiary Centres Professionals Carers/Parents Any person who has some relationship with Child or Family Referred through Customer Services Desk and single service request form If universal and targeted service unable to meet need Safeguarding referrals regarding CYP with ASD will be picked up by Disabled Children's Team 0-18yrs Team around the child Health Professionals SENCO Social Worker School Health Professionals Health Professionals Pre-school Children without ASD diagnosis considered by intake panel who determine team and support Must have Autism Diagnosis for the Communication Disorder Team - intervention and type determined by Intake panel Up to 16 years old mainstream Up to 19 if in special school, GP in East and North Herts (exception for those who attend special school ) Some evidence of autism or other developmental disorders Up to 16 years old mainstream; Up to 19 if in special school, GP in West Herts for Community Paediatricians Some evidence of autism or other developmental disorders Social Work assessment key worker to coordinate services Child in need meetings Provision of respite/ equipment/ ongoing package of care to support in home or foster care level of intervention/ package dependent on need Training for school and Parents Home visiting service Weekly Support Groups Evidenced Based advice on strategies and interventions. Systemic support Assessments Cognitive assessments (Ed Psych) Diagnostic pathway and assessments Do joint assessments with SALT and school Create a profile of strengths and difficulties/needs and a care plan even if no diagnosis Follow up in clinics Diagnostic assessments dependent on need Provide therapy services around Occupational Therapy incl. sensory profiling/ Speech and Language/ challenging behaviour service Medical management including medication CAMHS CBPS LD Psych service Angels Stop Gap HV (behaviour management) CPBS Challenging Behaviour Autism Advisory Service; over 5 years need a diagnosis to access CAMHS Diagnosis of ASD and/or Learning Disability and challenging behaviour 0 – 16 years or 19 years if in specialist education Evidence of appropriate community service attempted Registered with GP in Hertfordshire Seen and assessed by referrer Family Consent to referral Assessment of Challenging Behaviour including extended assessment/ functional analysis Direct interventions short and long term Direct work with Parent/Carer/ Professionals Consultation to Parent/Carer/ Professionals Training to Parent/ Carer/Professionals Joint Work with CAMHS if indicated CS – Disabled Children’s Team CS OT Specialist CAMHS Vol. sector – KIDS HUB Scaffold SALT Young Carers Parent Partnership CAMHS Challenging Behaviour Psychology Service Step 2 (Tier 2 CAMHS provided by HCT) Adult Care Services These services are provided by a number of teams including: Early Years SEND Communication, Disorders Team (prev called Autism Advisory Service), Education Psychology, Behaviour & Attendance Parent Support Groups CBPS CAMHS Discharge/ Handover Back to referrer or to other services as indicated above. Hertfordshire County Council (HCC) Interventions Criteria Referrers Adult Very few discharged and if they are, then this is handed over to universal services or Adult Care Services (transition team). Closed when service no longer needed by the school (but can re-refer if needed). Hertfordshire Community NHS Trust (HCT) OT & SLT Health Professionals Call Centre Children’s Services Stop-Gap Connexions Probation Parents Paediatricians GPs Health visitors Schools Advisory services Educational psychologists & other educational professionals Occupational therapy Physiotherapy CBPS and Tertiary Centres HCT health professionals Children’s services OT Fair Access to Referrals accepted according to presenting Care problems, not diagnosis; diagnosis not Resident of recorded as primary reason for referral Hertfordshire Registered with Herts GP 18 yrs + SLT Transitions team IQ 70 and under Age 0-16 (in new specification 0-18); also 1619 for those young people who have a statement of their SEN attending Herts schools Service operates across Herts Clinical guidelines based on developmental speech, language and communication norms OT Adults with Asperger’s Social Sensory workshops: advice to parents & schools on strategies to develop sensory & motor skills; Care Team treatment to address motor difficulties; may include Individual budgets the use of sensory integration principles. / service SLT Benefits guidance Functional communication assessments: Formal assessment as appropriate; parent workshops; Person centred makatron signing training support plan Integrated intervention & support programmes to Promoting using the educational setting linking functional level of mainstream communication with national curriculum levels services 1-2-1/group work in most effective environment Learning Disability Training for families & staff on specific approaches, services for those e.g. Picture Exchange Communication System (PECS) with IQ less than Social Stories Elklan training for schools: support in classroom, 70 Once they have a diagnosis, back to referrer or to other services indicated above. Hertfordshire Partnership Foundation Trust (HPFT) Refer on to CAMHS LD Psych Service Angels Stop Gap HV (behaviour management) CPBS Challenging Behaviour Autism Advisory Service (over 5s need a diagnosis to access) Hertfordshire Partnership Foundation Trust (HPFT) CAMHS Adult Health Professional/ Social Worker if key worker lead professional for TAF Educational Psychologist CBPS (for tier 4 - only consultant paediatrician/ tier 3 CAMHS, CBPS) Single Point of Access (SPA) Health Professionals Call Centre (self or family) Children’s Services Stop-Gap Connexions Probation Up to 18yrs and up to 19 if in special school GP in Hertfordshire CYP has severe, complex &/or persistent difficulties presenting as emotional/ behavioural symptoms Appropriate Community service has been tried Very severe presentation e.g. psychosis, risk of suicide, eating disorders CYP has been seen by referrer and family agree to referral Tier 4 - only if consultant paediatrician/ tier 3 CAMHS, CBPS accepts referral Diagnostic assessments - Primary; Second Opinion and Co-Morbid Art therapy Speech and Language Occupational therapy Psychiatric assessment Cognitive and scholastic Socio-emotional functioning Mental health Emotional well being Medication Bespoke cognitive behavioural therapy Family therapy/interventions 18 - 65 yrs Hertfordshire Partnership Foundation Trust (HPFT) Catchment area Mental health difficulty/ meet ‘Asperger-friendly’ FAC criteria Impaired functioning in activities of daily living IQ over 70 complex needs. Day Opportunities Work solutions Accommodation Solutions Signposting to voluntary groups/ services Back to referrer or to other services indicated above. Challenging Behaviour Psychology Service Paediatricians Tertiary commissioning including Great Ormond Street and The Maudsley ADDVANCE Autism Advisory Service Children’s Services Adult Mental Health Services (transition starts at 17½) Diagnostic assessments Fair Access to Care Assessments Psycho-educational package to parents Psychologically informed interventions Acer’s assessments for carers Allocation of a care coordinator - assess for personal budget or act as advocate. Supervising/ consulting to other organisations NAS Work Solutions Vision Turning Point MIND Viewpoint Crossroads Guidepost Trust Living Autism Discharge/ Handover May be transferred to Third Sector Providers. Likely to require varied levels of support from services through life. OT: If targets are met or the child and family have strategies to manage their condition Move out of area SLT: Children are discharged once they develop functional communication skills commensurate with their overall abilities; adults are able to provide appropriate support by becoming more aware of the child’s communication skills and have an understanding of how they can adapt to maximise functional communication in everyday situations Back to referrer or to other services as indicated above. Back to referrer or to other services indicated above. When Personal budget not needed. Does not meet FAC criteria.